ORIGINAL PAPER Copyright © Celsius Publishing House www.sgo-iasgo.com Surg. Gastroenterol. Oncol. 2019;24(5):241-246 DOI: 10.21614/sgo-24-5-241 241 Surgery, Gastroenterology and Oncology, 24 (5), 2019 Surgical Treatment of Synchronous Colorectal and Renal Neoplasms Ivelin Takorov 1 , Tsvetan Trichkov 2 , Radoslav Kostadinov 2 , Maria Yakova 2 , Tsonka Lukanova 2 , Vassil Mihaylov 2 , Nikola Vladov 2 Corresponding author: Tsvetan Trichkov MD 3 Georgi Sofiyski Str., ZIP-code 1606, Sofia/Bulgaria Phone: +359886501510 E-mail: cvetantrichkov@gmail.com ABSTRACT Background: Synchronous tumors are rare clinical entity. In most cases, they are found accidentally in the process of primary tumor staging. The detection rate of synchronous blastomas has increased over the past decades due to the advance and more frequent use of imaging modalities. Only a few cases of colorectal carcinoma (CRC) and concurrent incidental renal tumors have been reported in recent years, with their incidence rates varying as reported by different authors (0.043-4.85%). Methods: We performed retrospective analysis of our database for patients, admitted for elective colonic resection for CRC, who had adequate preoperative staging (abdominal CT or MRI), and presented with simultaneous renal tumors. Between 2009 and 2018 we identified 1472 cases of CRC. Of them 1345 underwent radical surgery, preoperative imaging was available for 1117 patients (83%), among whom 4 were diagnosed with synchronous neoplasms (0.35%). Results: The average age in our group was 52.5 years (43-63), with male/female ratio of 1:1. CRC was the initial diagnosis, and renal tumors were accidentally detected by CT scan in the staging process. Three of the patients had combination of rectal and left kidney cancer, and one had ascending colon cancer and right kidney cancer. All 4 patients underwent simultaneous removal of both tumors: two patients underwent open and two laparoscopic procedures. Conclusions: Although rare, synchronous colorectal and renal tumors may be encountered, mainly thanks to preoperative diagnostic imaging. Performing simultaneous resection is safe and is not associated with increased complication rate. The laparoscopic approach is a viable option, when performed by an experienced team. Key words: synchronous colorectal and renal tumors; simultaneous resection; laparoscopic colorectal resection; laparoscopic nephrectomy; synchronous tumors INTRODUCTION INTRODUCTION According to Warren and Gates criteria, primary tumors may simultaneously occur in two different organs. Additionally, patients with 2 synchronous tumors are at risk of developing other malignancies (1). Cases of coexisting colorectal and renal neoplasms do not relate to certain syndromes, such as type I and II papillary renal cell carcinoma, familial non-syndromic clear cell renal cell carcinoma, Von Hippel-Lindau syndrome, tuberous sclerosis (1). Patients diagnosed with colo- Received: 15.08.2019 Accepted: 25.09.2019 1 First Clinic of Abdominal Surgery; 2 Department of HPB and Liver Transplant Surgery Military Medical Academy, Sofia, Bulgaria